top of page

Sweden's Karolinska ends use of puberty blockers for minors under 16

The "Dutch Protocol" for the treatment of minors with gender dysphoria has been abandoned due to risks of medical harm and uncertain benefits. 

BySEGM, Society for Evidence based Gender Medicine


Karolinska Hospital, Sweden, recently released a new policy statement regarding the treatment of minors with gender dysphoria in its Pediatric Division of Gender Services. This policy, which took effect in April 2021, ended the practice of prescribing puberty blockers and transgender hormones to minors under the age of 16. Hormonal interventions for young people aged 16-18 are still allowed, but only in research approved by the Swedish ethics review board, after thorough informed consent that reveals the significant risks and uncertainties of hormonal interventions and takes account of the minor's level of maturity and ability to give genuine informed consent.


This is a decisive moment. Sweden is the first country in which a renowned hospital has explicitly stopped following the Dutch protocol, which allows the administration of puberty blockers at the age of 12 (and increasingly, from 8-9 years old, at the stage precocious puberty known as Tanner 2), and transsexual hormones at age 16. It is also the first country to officially deviate from the WPATH guidelines. WPATH has long positioned itself as the global authority on transgender health. However, over the past few months, health authorities in several countries have conducted their own review of the evidence and found it to be insufficient to justify the early medical interventions advocated by the WPATH guidelines.


Sweden's new policy is consistent with Finland's recently revised guidelines, which have been amended to prioritize psychological interventions and support over medical interventions, especially for young people without a history of gender dysphoria in childhood (currently the most common presentation). Significant changes are also underway in the UK, following the High Court's ruling that found hormonal interventions on minors experimental, and warned that minors are rarely able to provide truly informed consent for interventions with such profound consequences throughout their lives. The NHS (National Health Service) recently suspended the initiation of hormonal interventions for minors under the age of 16. This decision is currently under appeal, with the hearing scheduled for June 2021.


In the United States, the debate over the treatment of minors with gender dysphoria has become politicized, with some states introducing laws prohibiting the use of various hormonal interventions in minors, while other states are considering legislation to prohibit psychological treatment modalities for gender dysphoria. As the international community becomes aware of the low quality of evidence for potential benefits and harms of medical interventions in minors with gender dysphoria, it is expected that the focus will shift to options. non-invasive to ameliorate distress, such as the provision of ethical psychological treatment and support.

See the original articlehere.

bottom of page